Manon Short, RPT, hooks a sling up to the lift of the bariatric sit-to-stand unit.

Feeling pain is not included in a PT's job description, despite the fact that many PTs seem to think it belongs there. PTs have accepted soreness as a way of life, a sacrifice to be made to provide the best possible care for patients. Too often, they think that the use of patient-handling devices will impede a patient's ability to improve functioning. But as patient-transfer and patient-handling devices have improved, and awareness of ergonomics has increased, PTs have become more open to incorporating this equipment into their work.

"PTs tend to think they don't need to use technology but rather should do it themselves. But we are starting to get more buy-in, as PTs realize there is technology out there that can help and not impede a patient's ability to improve functionally," says Manon Short, RPT, injury-prevention coordinator at Tampa General Hospital, Tampa, Fla.

Short oversees the injury-prevention program at Tampa General, a role she has filled since 2000. During her first 2 years, she evaluated the hospital's patient-handling needs and got to know each department. In 2002, the hospital began to purchase patient-handling equipment. Short estimates it has spent roughly $500,000 during that time period, and she has already seen a return on its investment.

"We used to spend close to $500,000 a year on injuries related to moving patients. Last year, we spent only $16,000, a 95% reduction in cost," Short says.

SAFETY VERSUS THERAPY

Ironically, PTs experience a high rate of work-related injuries. According to one 1999 study, 32% of PTs and 35% of PTAs reported sustaining musculoskeletal disorders, with the most common injury in the low back.¹ The second most common injuries occurred in the upper back and the hand and wrist.¹

A more recent survey (2004) in Turkey found that 85% of the 120 PT respondents reported at least one musculoskeletal injury in their lifetime.² Again, low back and hand-wrist injuries were the most common and second-most common areas, respectively.² The highest risk factor for injury was patient transfers (15%).²

When Short first graduated from a PT program 15 years ago, patient-handling equipment was not mechanized. "There were some lifts, but much of the equipment had manual cranks and pumps and chains," recalls Short. Often, PTs adopted equipment to get patients up, such as transfer boards. Gait training could involve four PTs: two to hold the patient up and two to move the legs. Short jokingly refers to this time period as the "caveman years."

Now, equipment can provide some or even all of the needed power and support required to move patients. PTs have considered this equipment warily, reluctant to use devices they felt could negatively impact a patient's improvement in functioning. In the past, a PT would do whatever it took to get a patient out of bed, even if it required five personnel. "Now, we have to consider whether this type of transfer offers any therapeutic benefit. We need to ask if the patient gains anything functionally through the transfer, particularly if they are unable to participate," says Short. If not, then Short recommends lifting equipment.

LIFTS, TWISTS, AND SLIDES

Patient-handling equipment has incorporated many enhancements during the 15 years Short has been in the field, including less cumbersome mechanisms (no more chains), power-driven mechanisms, bigger casters to aid movement, higher weight capacity, better sling technology, and easy-to-clean materials.

One of Short's favorite advances is the ceiling lift, which often requires very little operator labor. The lift is electronically controlled via a panel or handheld device; lateral motion may be completed mechanically or with power. Ceiling lifts can be permanently mounted or portable, and they are often very adaptable to the environment.

"There are so many things a ceiling lift can do—transfer the patient into or out of bed, put him into a stretcher, walk the patient, and turn the patient. They are not cumbersome, and there is no storage issue. They are also not as expensive as one might think," Short says. She notes that ceiling lifts are appropriate for both hospital and clinic use. Tampa General uses one in its outpatient gym. PTs use the ceiling-lift tracks with walking slings to help ambulate patients.

But ceiling lifts are not the only helpful devices. Pivot disks, which are circular, rotating devices that go under a patient's feet, assist with proper positioning. One-way glide cushions prevent less ambulatory patients from sliding out of their wheelchairs. Gait belts provide secure grasps for practitioners to use when training or transferring patients.

Short prefers the simplest gait belts. "Vendors sell them with handles and fluffy materials and other design elements, but we find these present infection or other safety issues," Short says.

But she has not done much research on gait belts, focusing instead on larger equipment as well as devices for larger patients. Short estimates that most equipment handles up to 400 pounds. "This meets 90% to 95% of the population. But that still leaves 5% [of the patients at Tampa General] who will exceed that limit," Short says, noting that the hospital has admitted a number of 500-pound and 600-pound patients recently. As devices with higher weight capacities—first 600 pounds, then 800 pounds, and now 1,000 pounds—have become more common, Tampa General has purchased them. "Our floor lifts need 600-pound to 1,000-pound weight capacities," Short says. The hospital recently invested in a bariatric lifting device able to provide sit-to-stand capabilities, with a typical weight limit of 420 pounds.

LAYING MONEY DOWN

Higher weight capacities come at higher prices, but budget isn't the only factor Short considers when making purchasing decisions. "I involve a team when deciding which piece of equipment to buy, and we do not purchase anything without evaluating it on actual patients," Short says. These evaluations allow the team to determine whether the piece will work.

Infection control is another consideration. Short prefers easy-clean surfaces. "We love wipe-down materials. But if we can't wipe them down, we want to be sure they can sustain high temperatures during washing," Short says.

Short says that Tampa General's patient-handling budget was tight, so cost was spread out over time. The benefit is that returns on the investments have been seen in as few as 2 years. Since 2002, injuries related to patient handling (transfers and repositioning) have fallen 62%, with a resulting 95% reduction in related costs.

Left: Patient Randy Ramnauth ambulates with the eva walker with a ceiling lift attached in case his legs buckle. The lift prevents him from falling. Right: Katherine Southworth, PT, assists Ramnauth with terminal knee extension.

APPOINTING A LEADER

These savings are not related solely to the integration of new equipment, however. Short credits four elements of a focused injury-prevention program with making the hospital's patient-transfer program a success: proper equipment, management and employee buy-in, lift teams, and a full-time overseer or coordinator.

"Just buying equipment or setting up a lift team has not been shown to have a positive impact on an institution," Short says. On the other hand, those hospitals that have hired injury-prevention specialists have seen improvements. Programs run by a hospital's existing staff members tend to suffer as the injury-prevention specialists must also fulfill the requirements of their regular full-time employment.

Short believes PTs are best equipped to fill the injury-prevention coordinator role. "They are not as technical as ergonomists, and because of their experience, understand the clinical side," she says.

Short spent the first 2 years in her role as injury-prevention coordinator visiting each of Tampa General's more than 30 departments. One of her goals was to foster buy-in by gathering data and establishing relationships. "You need to study the facility, look at injuries and cost, and pull the data before you start so you can prove and evaluate outcomes," Short says.

She gathered data that included number of injuries, related causes, associated costs, available equipment, room layouts, department layouts, and storage space. "Storage space is a huge issue for this equipment," Short cautions.

Short handles injury prevention for the entire hospital, so she met managers and staff and spread awareness about her plan. This includes the 12 lift team employees who are available to move patients nearly 24/7 and are key to the program. The two-person teams are available 21.5 hours every day, with two teams working during the day and one team working at night. They assist with high-risk patient transfers, emergency transfers, and repositioning. Short estimates they receive about 100 calls per day, and roughly half of the lift teams' day time is devoted to repositioning. "They are the leaders in safe patient handling," Short says.

For related information on the importance of lift teams, read our June 2006 feature, "Handle with Care."

Lift teams are called by PTs to place immobile patients in bed. "If the patient can help, the therapist will generally use a lift device to assist the patient transfer," Short says. However, if a lift team has been called, the therapist does not need to be present for the transfer; a nurse or other provider who knows the patient can be present instead. The PT can leave specific instructions for the lift team if necessary. Short notes that this allows PTs to spend more time in therapy and to leave on time. PTs used to frequently get calls at the end of the day from departments wanting help returning a patient to bed, Short recalls. "Now, the PT can get the patient out of bed in the morning and have the nurse call for the lift team in the afternoon," Short says, noting that lift teams have improved the nurse-PT rapport.

All employees are required to attend a 3.5-hour, multidisciplinary training class. Short works closely with professionals throughout the hospital, including the nurses who treat workers' compensation patients, workers' compensation case managers, facilities staff, biomeds, purchasing, and therapists. "We want people to understand that there are a lot of components [to an injury-prevention program]. Lift teams are one component, but without the equipment or support they need, they will not succeed," Short says.

NO LIFT, NO WAY

Short would like to see some new trends take hold. No-lift or zero-lift policies should be abandoned as people realize that achieving zero lifting is not possible 100% of the time. "The reality of putting a lifting device on everybody is impossible," Short says. She offers turning slings as an example. "These do not work on everybody. Patients with pressure sores, burns, or unstable spines are difficult to turn with devices," Short says.

Instead, she advocates low-lift policies. "In 90% of cases, you can use technology and institute safe patient handling, but 10% will need to be done manually," Short says. She notes that therapists do a lot of repositioning, in part because of a lack of equipment designed to assist with this function.

Short has done her homework, gathering data that shows that the integration of patient-handling technology improved Tampa General's employee safety—and its bottom line. She continues to work on PT buy-in, noting that the promotion of safe patient handling belongs in PT curricula.

"PTs need to get on the cutting edge," Short says. "Most think it's their job to be sore. But they don't have to break their backs."

Renee DiIulio is a contributing writer for  Physical Therapy Products. For more information, contact .

References

1. Holder, MI, Clark, H, DiBiasio, JM, et al. Cause, prevalence, and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants. Phys Ther. July 1999;79(7):642-652.
2. Salik, Y and Ozcan, A. Work-related musculoskeletal disorders: A survey of physical therapists in Izmir-Turkey. BMC Musculoskelet Disord. 2004;5:27.